Three year funding is sought to compare outcomes and cost of intensive case management with more traditional community based care to the chronically mentally ill. Two treatment sites have recently initiated programs of intensive case management for a selected population of multiproblem chronic mentally ill clients. Since neither agency can accommodate all eligible clients in the new programs, a unique opportunity to study a matched cohort of traditionally treated clients exists. In addition, extensive fiscal data on treatment costs are available at both treatment sites. The specific aims are to: 1) Compare the outcomes of chronic mentally ill clients treated with intensive case management with those of a matched cohort receiving traditional community mental health services. 2) Assess the cost of the two types of programs and their relationship to treatment outcomes. 3) Assess the total cost of caring for clients in the public mental health system. An interrupted time-series quasi-experimental design involving an experimental group and two matched control groups at two sites will be used. Clinical outcome and cost data will be collected at intervals throughout 3 years of the project in order to evaluate the cost effectiveness of intensive case management as a modality of care for the chronic mentally ill. A cost- effectiveness matrix will be developed to inform future decisions on the use of intensive case management with the chronic mentally ill.